Antidepressants May Help With Heart Disease

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For some patients with heart disease, taking antidepressants may
reduce the risk of heart problems brought on by mental stress, a
new study suggests.

Researchers looked at patients with myocardial ischemia — a
condition in which the heart doesn't get enough blood — as they
performed mentally stressful activities.

All of the patients also had coronary
heart disease, or a narrowing of the arteries that supply
blood to the heart.

Patients in the study who took the antidepressant escitalopram
(sold as Lexapro) were about 2.5 times less likely than those who
took a placebo to experience myocardial ischemia triggered by
mental stress.

The findings suggest that an antidepressant, or other treatments
that help patients cope with stress, could improve symptoms for
some people with coronary heart disease, said study researcher
Dr. Wei Jiang, an associate professor of psychiatry and
behavioral sciences at Duke University School of Medicine.

However, future studies are needed to confirm the results, and to
identify the people most likely to benefit from such treatment,
Jiang said.

About 30 years ago, doctors observed that
mental stress could bring on myocardial ischemia. Studies
also have found that people with mental-stress-induced myocardial
ischemia are at increased risk of dying from heart disease.

Coronary heart disease is the leading cause of death in the
United States — and about 50 percent of patients with the
condition experience mental-stress-induced myocardial ischemia —
yet few studies have attempted to find treatments.

In the new study, 127 patients were randomly assigned to receive
escitalopram or placebo for six weeks.

Participants completed a number of tests at the beginning and end
of the study, including a treadmill stress test, a math test and
a test in which participants told a sad story in order to evoke
emotion.

During the tests, the researchers examined certain
heart symptoms to diagnose myocardial ischemia, such as a
reduction in blood pumped out of one of the heart's cambers.

After six weeks, about 34 percent of participants taking the
antidepressant did not experience myocardial ischemia during the
mental-stress tests, compared with 17 percent in the placebo
group.

The antidepressant did not affect whether patients experienced
myocardial ischemia during exercise.

Dr. Andrew Freeman, a cardiologist at the National Jewish Health
hospital in Denver, said it was not very surprising that drugs
that blunt the brain's response to stress would also blunt the
heart's response to stress.

But what the findings mean for patients in the long term is not
known, said Freeman, who was not involved in the study. Future
studies are needed to see whether antidepressants might reduce
the risk of cardiovascular events like heart attacks, Freeman
said.

How does it work?

It's not clear how antidepressants lower the risk of myocardial
ischemia in these patients. The findings did show that patients
who took antidepressants were more likely than those who took the
placebo to say that they felt like they were in control, and less
tense or upset, during the mental-stress tests.

Some earlier studies that looked at the effect of
antidepressants on patients with both coronary heart disease
and depression found that the drugs did not benefit patients more
than a placebo did, Jiang said. But patients may not necessarily
need to suffer from depression to be susceptible to
mental-stress-induced myocardial ischemia, she said.

Antidepressants do have side effects, including fatigue and
sexual dysfunction. Therefore, future research is needed to
understand which patients are likely to benefit most from the
drugs, Jiang said.

The study is published in the May 22 issue of the Journal of the
American Medical Association. Jiang has a patent application
related to antidepressant treatment for mental-stress-induced
myocardial ischemia.